LESSONS 


from 

THE LIFE OF 

Florence Nightingale 


By CHARLOTTE A. AIKENS 

It 

Author of “Hospital Training School Methods and 
the Head Nurse,” Primary Studies for Nurses,” 
Clinical Studies for Nurses,” “Studies in Ethics for 
Nurses,” etc. Joint A uthor of Hospital Management. 
Editor “ The Trained Nurse and Hospital Review.” 




Lakeside Publishing Company 
38-40 West 32nd St. 

New York. 







FLORENCE NIGHTINGALE 
Born in Florence, Italy, May 12th, 1820 ; died in London 
August 13th, 1910 

/ 

©CI.A414298 

flCT 28 1915 

/ i 






SANTA FILOMENA 

By Henry Wadsworth Longfellow 

Whene’er a noble deed is wrought 
Whene’er is spoke a noble thought 
Our hearts, in glad surprise, 

To higher levels rise. 

The tidal wave of deeper souls 
Into our inmost being rolls 
And lifts us unawares 
Out of all meaner cares. 

Honor to those whose words or deeds 
Thus help us in our daily needs. 

And by their overflow 
Raise us from what is low! 

Thus thought I, as by night I read 
Of the great army of the dead, 

The trenches cold and damp, 

The starved and frozen camp. 

The wounded from the battle-plain 
In dreary hospitals of pain, 

The cheerless corridors, 

The cold and stony floors. 

Lo! in that house of misery 
A lady with a lamp I see 
Pass through the glimmering gloom, 
And flit from room to room. 

And slow, as in a dream of bliss, 

The. speechless sufferer turns to kiss 
Her shadow, as it falls, 

Upon the darkening walls. 

As if a door in heaven should be 
Opened and then closed suddenly, 

The vision came and went, 

The light shone and was spent. 

r 

On England’s annals, through the long 
Hereafter of her speech and song 
That light its rays shall cast 
From portals of the past. 

A Lady with a Lamp shall stand 
In the great history of the land 
A noble type of good 
Heroic womanhood. 

Nor even shall be wanting here 
The palm, the lily and the spear 
The symbols that of yore 
Saint Filomena bore. 












Lessons from the Life of 
Florence Nightingale 

Chapter I. 

The presence of thousands of daughters of Florence 
Nightingale in the regions devastated by the great 
world war, and the great service to humanity which 
they have rendered, have turned the thoughts of many 
to that other battlefield where the great need of the 
world for trained nurses was first impressed on the 
hearts of the people — an impression never to be 
effaced while there are suffering human beings re¬ 
quiring skilled care and service. 

Sixty odd years ago, at the outbreak of the Crimean 
war there were no women nurses to minister to those 
who had been wounded in the service of their country. 
Woman’s ministry was sorely needed but not wanted 
by those in active command of military affairs at the 
seat of war. It remained for Florence Nightingale to 
teach the world one of its greatest lessons—a lesson 
from which future generations will reap increasing 
benefits. When the Crimean war closed, the founda¬ 
tion was begun on which the structure of modern 
nursing was to be reared. 

In every age, the world has had its heroes, and 
Florence Nightingale would have been the last to wish 
to give the impression that there were not many 
splendid women devoting themselves to the care of the 
sick long before she was born. They were not trained 
women according to modern ideals of training, but 
there were women of gentle birth and breeding, refined 
and accomplished who served the sick with singleness 
of heart and rare devotion. The world will always owe 
its debt of gratitude to the Roman Catholic Sisters 


6 


Florence Nightingale. 


and the Deaconesses of other churches, whose tender 
ministries to the sick in hospitals and home, did much 
to lessen the sum of human suffering in the years 
before Miss Nightingale’s great work was begun. 

No one who reads the story of the beautiful life of 
Florence Nightingale can fail to be impressed with the 
fact that the dominant motive of that life was—SER¬ 
VICE. tit has been aptly said that one of the first and 
most iniportant lessons that a nurse needs to learn, is 
to spell SELF with a little s. In this she has a worthy 
example for forgetfulness of self seems to have been 
characteristic of Florence Nightingale all through her 
life. ^ Service to humanity—especially service to the 
sick and distressed part of humanity—seems to have 
made its strong appeal to her almost from childhood. 
Organization for service, education and training for 
service, plans for service in a hundred different ways— 
filled her life, and the story of her many-sided activi¬ 
ties, as revealed by her official biographer—has been 
a surprise to those who have thought of her only in 
connection with nursing. While she will always be 
best remembered as the founder of modern nursing, 
her great efforts in improving sanitary conditions in 
India, in which she labored unceasingly for many 
years with officials in the War Department, and her 
work in behalf of reform in the management of work- 
houses in England, were closely interwoven with her 
work in behalf of better nursing for the sick. Her 
voluminous correspondence and her literary work 
seem in themselves to have been sufficient to occupy 
her full time, after her return from the Crimea. 

The popular idea of Florence Nightingale has been 
drawn largely from the pen picture of Longfellow in 
Santa Filomena, but it is far from being a true picture 
of her life. To fully appreciate her character and in- 


Lessors From Her Lifi5. 


7 


fluence one must study to some extent, not alone the 
social and sanitary conditions that prevailed in her 
earlier life, but the habits of thought and even the 
etiquette of the times, during which her chief work 
was being accomplished. Of these conditions her 
biographer says: 

“Now that the fruits of Florence Nightingale’s 
pioneer work have been gathered, and that nursing is 
one of the recognized occupations for gentlewomen, 
it is not altogether easy to realize the difficulties which 
stood in her way. The objections were moral and 
social, in large measure rooted to conventional ideas. 
Gentlewomen, it was felt, would be exposed, if not to 
danger and temptations, at least to undesirable and 
unfitting conditions. ‘It was as if I had wanted to be 
a kitchen maid,’ Miss Nightingale herself said in later 
years. Nothing is more tenacious than social preju¬ 
dice. But the prejudice was in part founded on very 
intelligible reasons and in part was justified by the 
level of nursing as an occupation at that time. It will 
suffice to say that though there were better-managed 
and worse-managed hospitals, yet there was strong 
evidence to show that hospital nurses had opportuni¬ 
ties which they freely used, for ‘putting the bottle to 
their lips’ when so disposed, also that other evils were 
more or less prevalent. 

“The more she heard of the worst, the more was 
Florence Nightingale resolved to make things better; 
but the more her parents heard, the greater and more 
natural was their repugnance. Somebody must do the 
rough pioneer work of the world; but one can under¬ 
stand how the parents of an attractive daughter, to 
whom their own life at home seemed to them to open 
many possibilities of comfortable happiness, came to 
desire that in this case the somebody should be some¬ 
body else.” 


8 


Florence Nightingale 


It is difficult to study her life without feeling that 
she was sent into the world especially to accomplish 
the great tasks to which in early middle life, her pow¬ 
ers were chiefly devoted. It should, however, be al¬ 
ways remembered that during this period others be¬ 
sides Miss Nightingale were making their contribution 
to better nursing and better sanitary conditions in hos¬ 
pitals, and in the world outside. (Lord Lister, who ush¬ 
ered in the new era of antiseptic^surgery, was seven 
years younger than Florence Nightingale. “He and 
she, each in the manner in which Nature or Providence 
fitted them, were simultaneously inaugurating the new 
era, he the foster father, she the foster mother of 
myriads of this generation and unthinkable millions 
of those who are to be/ His methods demanded the 
trained nurse both for surgery and midwifery, both for 
the battlefield where life is destroyed, and for the ly¬ 
ing-in room where it is ushered into separate existence. 
Her work was to provide the training and the princi¬ 
ples, the ideals, the enthusiasm, and the tiniest, hum¬ 
blest details, whereby the modern nurse is made.” 

Apart entirely from the generally undesirable type 
of women (there were many exceptions) found in 
charge of the care of the sick when Florence Nightin¬ 
gale began her work, were the generally undesirable 
conditions which existed before Lord Lister’s antiseptic 
methods were inaugurated in 1868. Erysipelas, gan¬ 
grene, pyemia, and septicemia were common compli¬ 
cations of surgery and the death rate of maternity 
patients in hospitals was appalling. A nurse who was 
one of the pioneers in improving the care of the sick, 
thus describes her experience when she entered for 
training in an English hospital: 

“New methods of nursing as well as of surgery had 
to contend with tremendous difficulties in the way of 



LORD 


LISTER 





10 


Florence Nightingale 


bad buildings, bad ventilation, old-fashioned furniture, 
and lack of apparatus. 

“The utensils, which in the hospitals of today are 
of white earthenware or enamel, were of exceedingly 
battered tin, almost entirely denuded of their original 
covering of black japan, and it was absolutely impos¬ 
sible to keep some of them clean and sweet. Smells 
abounded. I have seen a visiting surgeon run through 
a ward to escape them, and during my first week I 
was much puzzled by the existence of a horrible smell 
in one corner of the children’s ward. I privately in¬ 
vestigated the floor and under the beds, but could find 
nothing to account for it, but discovered at last that 
it came from a patient—a child with a diseased bone 
of the face, a case which nowadays would be antisep- 
tically treated and probably isolated. 

“Under the old regime the nurses had, as a rule, no 
uniform dress, and cooked their own meals, which 
they bought for themselves, in the ward kitchens or 
scullery, and these conditions did not at once pass 
away. 

“The antiseptic treatment of wounds was coming 
into general use, and the particular method of the 
moment, which had been advocated by Dr. Lister, was 
a sort of model steam-engine, which could be carried 
about and placed on a table or stand by the side of a 
patient’s bed. When a wound was to be attended to, 
before the dressings were removed a lamp in this ap¬ 
paratus was lighted. A strong spray of diluted car¬ 
bolic acid then played over the wound the whole time 
it was being dressed, much to the discomfort of the 
doctors and nurses, whose hands would be stiff with 
the carbolic and their ears dulled with the constant 
hissing and fizzing of the machine. Everything was 


Lessons From Her Life 


11 


saturated with carbolic at that time, wool, bandages, 
lint, gauze, etc., but in the course of a few years this 
treatment was entirely superseded. 

“Operations were comparatively free and easy per¬ 
formances. We nurses wore our ordinary dresses, and 
were kept busy washing sponges, which were used 
again and again, though they were boiled between the 
operation days. In the medical wards enteric cases 
were indiscriminately mixed with others, and tubercu¬ 
losis patients stalked about and expectorated freely.” 

Nurses of today, in common with the rest of the 
world, owe a greater debt of gratitude than most of 
them realize to Lord Lister who, by his surgical experi¬ 
ments, and his demand for trained nurses, helped so 
much in laying the foundations for the trained nursing 
of today. Other workers in the realm of bacteriology 
were aiding greatly in the remarkable developments 
which medicine and surgery were making in that 
period. 


THE SPIRIT OF VOCATION. 

An English writer, Miss Margaret Fox, in an ad¬ 
dress to nurses has called attention to the great need 
of the spirit of vocation in the nurses of today. “Look 
at it what way you will,” she states, “the fact remains 
that nursing is work demanding something more than 
mere business qualities, more than an active intelli¬ 
gence, more than even sympathy and kindness of 
heart. The latter, precious though it is, may be worn 
very threadbare in the constant daily contact with all 
sorts of unlovely natures suffering from every variety 
of trying ailment. Patients are not all grateful, or ap¬ 
preciative, and you will find some of them by no means 
ready to kiss your shadow as you pass on your rounds. 
Sometimes they are inclined to grumble because they 


12 


Florence Nightingale 


do not immediately get all they want. Their disease 
may make them irritable, captious even, sometimes, 
repulsive. These people need more than ordinary 
everyday good qualities in a nurse. They need one 
who, over and above her professional ability, looks up¬ 
on her work as a vocation, ‘a calling by the will of 
God.’ It was that spirit which made the best of the 
pioneers of other days what they were. Nursing was 
undertaken by them as a definite life-work. It cost 
them so much to enter upon it, that they were un¬ 
likely to throw it up without some very cogent reason. 
Work was not then considered so much a means to 
an end. It was the ultimate achievement. Nursing 
is a mission; and wherever it is done, it needs the same 
spirit of true vocation to do it well, and to persevere 
in spite of difficulties. 

“There would be fewer restless, discontented 
nurses, if each possessed the spirit of vocation. It is 
a spirit that gives one the calm, quiet feeling of being 
in the only possible place and doing the only possible 
work. It stirs in one a large-hearted charity towards 
all such as be sorrowful, sick or poor. It makes one 
feel, ‘Well, whoever fails, I must not.’ It helps won¬ 
derfully when things are crooked, and the work is 
hard, or uninteresting. One simply can’t help making 
things look nice, or doing the little extra bit which 
just makes all the difference.” 

The motives which influence an individual to un¬ 
dertake a task are tremendously important factors in 
real and full success, and it is well, in such work as 
nursing, that all who enter on it analyze carefully 
their own motives in so doing. 

There can be no mistaking the motives which led 
Florence Nightingale to enter, on her career under the 
distressing conditions which then prevailed. Born 


Lessons From Her Life 


13 


and reared in refined surroundings, in an intellectual 
atmosphere, with all the educational advantages the 
times afforded, if she had fulfilled parental and popular 
expectations, she would have been satisfied to have 
spent her girlhood life chiefly in a round of gay social 
functions, with ample leisure for study and travel, 
and to have married at an early age a man belonging 
to her own social circle. That she was not satisfied 
with this sort of existence is seen in this typical ex¬ 
tract from one of her letters, written when she was 
twenty-six years of age: “The thoughts and feelings 
that I have now,” she wrote, “I can remember since I 
was six years old. It was not / that made them. A 
profession, a trade, a necessary occupation, some¬ 
thing to fill and employ all my faculties, I have always 
felt essential to me, I have always longed for, con¬ 
sciously or not. # * * The first thought and the last 
thought I can remember was nursing work, but for 
this I have had no education myself. * * * ” Later 
she wrote: “In my thirty-first year I see nothing de¬ 
sirable but death. Why do I wish to leave this world? 
God knows I do not expect a greater heaven beyond, 
but that He would now set me down in St. Gile’s, or at 
a Kaiserwerth, there to find my work, and my salva¬ 
tion in my work.” 

To her, life was earnest—it was a serious thing, 
and her struggle for many long, weary years to free 
herself, to overcome the obstacles that closed in 
around her, so that she might accomplish the kind of 
work she felt God wanted her to do—her long-contin¬ 
ued effort to gain her relatives’ consent for her to even 
attempt nursing—forms one of the most interesting 
chapters in her life story. Nursing to her was always 
“God’s business.” 


14 


Florence Nightingale 


How much this sense of vocation, this strong feel¬ 
ing that she was called to do the will of God in this 
form of service, had to do with her success, no one can 
fully determine, but that it helped tremendously in 
carrying her over difficult places cannot be doubted. 
As one looks back over her wonderful life and tries to 
discern the secret of her remarkable influence, one 
cannot but feel that the spirit in which she did her 
work, her absolute devotion to the cause to which she 
was giving her best powers, accounts in large measure 
for her name being honored, and her memory kept 
green all over the civilized world. “The sweetest char¬ 
acter in all British history,” was a noted man’s com¬ 
ment on her, yet the sweetness was always combined 
with strength, and courage, and a quiet determination 
not to give up because things were harder or more dif¬ 
ficult than she had expected. Her work was not light¬ 
ly undertaken, and as lightly abandoned, as nursing is 
by many young women today. 

One of the outstanding qualities of this great 
woman was her individuality, a quality which some 
one has aptly said is close kin to honesty. She did her 
own thinking, and the results of that independent 
thinking were evident all through her career. In com¬ 
menting on this quality of individuality, a recent writ¬ 
er, Byron H. Stauffer, has said: 

“It burst out in a letter written when she was eight, 
which she closes with: ‘My love to all except Miss 
W—.’ It developed in her despising, early in life, the 
silly conventionalities of the high society of the day. 
It sparkled in explaining why she tittered during a 
ritualistic service: ‘The rector was praying “That it 
may please Thee to have mercy on all men,” and the 
ridiculousness of that prayer broke upon me. Think 
of it! If I asked you to have mercy on your own boy, 


Lessons From Her Life. 


15 


you’d knock me down.’ Another instance of her non¬ 
conformity to the religious conventions lies in her 
declaration: ‘I never prayed for George IV; I always 
thought that people were very, very good who could 
pray for him. It was a wonder to me how he could 
possibly be any worse if nobody prayed for him. I 
prayed a little for William IV. For the young Victoria 
I prayed with rapture.’ ” 

THE PRICE OF SKILL. 

( One of the tendencies of this age in nurses is to 
expect and apply for positions of responsibility for 
which they have not taken any special or definite 
pains to fit themselves. Their estimate of their own 
ability is often much greater than conditions justify; 
they often want the best positions without paying the 
price of special skill. The determination of Florence 
Nightingale to secure for herself the best instruction 
the world afforded at that time, and her conviction 
that if she was ever to accomplish anything worth 
while she must first learn all that was possible under 
the circumstances for her to learn about the business 
of caring for the sick, is a fine example for those who 
really desire to do worth while things in this world. 

It has been well said that ability depends greatly 
on preparation, and that opportunity is largely de¬ 
pendent on ability. It was by no accident that Flor¬ 
ence Nightingale became “the angel of the Crimea.” 
Nothing that she could do to fit herself for such a task 
had been omitted, though she could not know how 
great were the opportunities that were to be afforded 
her to use the knowledge and experience she was so 
determined to secure. She fully realized that to do 
good required more than good desires or intentions. 
To do good in the way that she wished required some 


16 


Florence Nightingale 


skill. To be the best possible nurse, to fit herself in the 
best way, however long it might take, or how hard the 
way might be, meant much greater difficulties then 
than it could possibly mean now. 

When in later years she expressed herself as fol¬ 
lows, she was simply expressing the convictions 
which had been with her all through life: 

“Nursing is an art, and if it is to be made an art, 
it requires as hard preparation as is required for any 
painter’s or sculptor’s work; for what is having to do 
with dead canvas or cold marble compared with car¬ 
ing for the living body?” 

How to obtain the needed skill was a problem which 
she had studied for many years. The difficulties and 
moral dangers that stood in the way of a refined 
woman securing experience in nursing in a hospital 
seemed for years insuperable, and can hardly be ap¬ 
preciated by the nurses of today. 

AT KAISERWERTH. 

Through a friend, Miss Nightingale learned of an 
institution for deaconesses at Kaiserwerth, Germany, 
where there was a school, a hospital and a prison, un¬ 
der the management of deaconesses. It had a decid¬ 
edly higher tone and reputation than prevailed in hos¬ 
pitals in general, she was told; and Pastor Fliedner’s 
annual reports of the work of the institution were 
eagerly studied, and used to silence parental objec¬ 
tions. The opportunity to spend a few months at 
Kaiserwerth was delayed, but finally came when her 
mother and sister, in search of health, went to Carls¬ 
bad, and to travel. In commenting afterward on the 
new departure of giving some months of training in 
the care of the sick, inaugurated at Khiserwerth, Miss 
Nightingale called special attention to the fact that 


Lessons From Her Life. 


17 


the Kaiserwerth institutions had begun, not with pro¬ 
grams or fullfledged schemes set forth in a prospectus, 
but with individual cases and personal devotion—and 
later years showed that her own great work began, 
also, not with a prospectus or prearranged program, 
but with actual doing of the thing she felt needed to 
be done when the opportunity came. The real train¬ 
ing in nursing given at Kaiserwerth was far from sat¬ 
isfactory to her, but the atmosphere, the spirit of con¬ 
secrated service, impressed her deeply. 

Later she returned to Kaiserwerth for further ap¬ 
prenticeship in nursing and followed this experience 
by spending some time in the hospitals of Paris pre¬ 
sided over by the Roman Catholic sisters. It is very 
evident that she did not expect to have everything she 
wished to know, prepared and presented to her to 
study. Her powers of observation were wonderful, 
and she proved an indefatigable collector of pamphlets, 
reports, statistics, methods of work and plans of hos¬ 
pital organization and management. 

One criticism which is often heard of present day 
nurses in training is that they so quickly get into ruts 
in the matter of observation—that they see so much in 
a hospital ward which they fail to perceive —that they 
fail to gather practical knowledge pertaining to their 
work which is all around them waiting to be picked 
up. If Florence Nightingale had been the type of 
woman who had to have all the nursing knowledge 
which she obtained duly imparted to her by somebody 
else appointed for that purpose, her influence on the 
conditions which then prevailed would have been small 
indeed. Instead, she was constantly getting hold of 
facts, reading medical books, continually studying in¬ 
to the “why” of things, and how they might be im¬ 
proved, s’crThat better general results might be ob¬ 
tained in the care of the sick. Her private notebooks 


18 


Florence Nightingale 


were filled with facts, ideas, and suggestions gathered 
here, there and elsewhere, which she was later to use 
in laying broad foundations for the improvement of 
nursing, and of hospital management in general. Her 
attention to small details, as found in her notebooks 
preserved to the present day, was characteristic of all 
her work, and accounts in no small degree for its suc¬ 
cess. 

TACT AND SENSE OF HUMOR. 

Among the indispensable qualities for successful 
nursing, we place “TACT” very close to the top of the 
list. To get along with people without friction, to get 
needful things done without arousing antagonism, to 
have that keenness of perception, that ready power of 
appreciating and of doing or saying what is most fit¬ 
ting under the circumstances; to maintain, withal, 
that quality of mind which enables one to see the 
humorous side to otherwise difficult situations, are 
qualities to be coveted by every nurse. 

How Florence Nightingale succeeded in managing 
committees with whom she had to work, as well as 
the sense of humor which helped to carry her over 
difficult situations, are admirably shown in extracts 
from her private letters, written soon after she re¬ 
turned from Kaiserwerth. She had been importuned 
to undertake the management of an institution known 
as an “Establishment for Gentlewomen During' Ill¬ 
ness,” which had been started, but had been so gross¬ 
ly mismanaged that it had been threatened with clos¬ 
ure. A change of location had finally been decided on 
when Miss Nightingale agreed to undertake its man¬ 
agement. One of the first difficulties which confront¬ 
ed her is described in the extract from a private letter 
to a friend which follows: 


Lessons From Her Life. 


19 


“My committee refused me to take in Catholic 
patients—whereupon I wished them good morning, 
unless I might also take in Jews and their Rabbis to 
attend them. So now it is settled, and w print, that 
we are to take in all denominations, whatever, and al¬ 
low them to be visited by their respective priests and 
Muftis, provided I will receive (in any case whatsoever 
that is not of the Church of England) the obnoxious 
animal at the door, take him upstairs myself, remain 
while he is conferring with his patient, make myself 
responsible that he does not speak to, or look at, any 
one else, and bring him downstairs in a noose, and 
out into the street. And to this I have agreed! And 
this is in print! 

“Amen. From committees, charity and schism— 
from the Church of England and other deadly sins— 
from philanthropy and all the deceits of the Devil— 
Good Lord deliver us!” 

To her father in 1853, she wrote another charac¬ 
teristic letter which affords a glimpse of the experi¬ 
ence in “managing” people she was getting at this 
time, and which was later to be most helpful in her 
great task of helping to reorganize the affairs of the 
army hospitals. In this letter, she says: 

“You ask for my observations upon my line of 
statesmanship. I have been so very busy that I have 
scarcely made any resume in my own mind. 

“When I entered into service here, I determined 
that, happen what would, I never would intrigue 
among the committees. Now I perceive that I do all 
my business by intrigue. I propose in private to A, B 
or C, the resolution I think A, B or C most capable of 
carrying in committee, and then leave it to them, and 
I always win. * * * I have observed that the opinions 
of others concerning you depend not at all, or very 
little, upon what you are, but upon what they are. 


20 


Florence Nightingale 


“Last General Committee I executed a series of 
Resolutions on five subjects and presented them as 
coming from medical men: 

“i. That the successor to our house surgeon (re¬ 
signed) should be a dispenser, thus saving our bill at 
the druggists of 150 pounds per annum. 

“2. A series of House Rules, of which I send you 
the rough copy. 

“3. A series of resolutions about not keeping 
patients. 

“4. A complete revolution as to diet, which is 
shamefully abused at present. 

“5. An advertisement for the Institution. 

“All these I proposed and carried in committee 
without telling them that they came from me, and not 
from the medical men; and then, and not till then, I 
showed them to the medical men, without telling them 
that they were already passed in committee. 

“It was a bold stroke, but success is said to make 
an insurrection into a revolution. The medical men 
have had two meetings upon them and approved them 
all, and thought they were their own. And I came off 
with flying colors, no one suspecting my intrigue. 

“I have also carried my point of having good, harm¬ 
less Mr. - as chaplain, and no young curate to 

have spiritual flirtations with my young ladies. So 
much for the earthquakes in this little mole-hill of 
ours.” 

Happy though Miss Nightingale was in this new 
work, it did not offer her the wide opportunity for 
training nurses, which she greatly longed to do— 
somewhat along the lines pursued at Kaiserwerth. 



* 




















































The Call to Service in the 
Crimean War 

Chapter II. 

When the Crimean war broke out in 1854, it can 
easily be imagined that there was no woman in Eng¬ 
land so well fitted to take charge of the chaotic situa¬ 
tion which soon developed in regard to the care of 
the wounded. The employment of women nurses in 
the army was an entire innovation. It excited jealousy 
in medical men, and strong criticism from military 
officers. In spite of the fact that the idea was certain 
to be branded as unwomanly by her own sex, and by 
the world in general, she offered her services, and her 
letter crossed in the mails a formal offer from Sir Sid¬ 
ney Herbert of the War Department of the position 
of director of a party of women nurses who were to 
be sent to nurse the sick. From France, a devoted 
company of Sisters of Charity had gone, who were 
rendering excellent service to the wounded, and it was 
felt by some officials who were not bound hand and 
foot by routine and precedent, that a company of 
women nurses from England might be sent to assist in 
the emergency that had arisen. Her services at this 
time are well known. The main facts were tersely 
summed up in the following paragraphs, published at 
the time of her death: 

“The death rate at Scutari was 42 per cent. In 
one hospital it rose to 56. Eighty per cent of those 
whose limbs were amputated died of gangrene. The 
sick list amounted to over 13,000. In the Turkish bar¬ 
racks on the Bosphorus there were two miles of sick 
beds, in a double file along the corridors. The rats 
ran over the wounds of the helpless patients. 


Service in the Crimean War. 


23 


“Miss Nightingale assembled a party of 41 volun¬ 
teer nurses, including ten Catholic nuns and eight sis¬ 
ters of mercy of the Anglican church, and took them 
to the Crimea. Upon her arrival at Scutari the “Lady 
of the Lamp” went straightway to work to bring order 
out of confusion, life out of the jaws of death, heaven 
on earth from a veritable hell. The day after her ar¬ 
rival they brought in the wounded survivors of the 
charge of the Light Brigade at Balaklava; the next day 
came the wounded from the bloody field of Inkerman. 
‘Red tape’ insisted that all stores should be inspected 
ere being issued to the troops. When she found that 
the inspection would take three days Miss Nightingale 
broke down the doors and commandeered the sup¬ 
plies. She had soon reduced the death rate from 42 
to 2 per cent. The wounded and the dying followed 
her with their eyes in her progress from cot to cot, as 
though she were an angel visitant. When, at the close 
of the war, a dinner was given the military and naval 
officers, those present voted for the one whose services 
would longest be remembered by posterity. There was 
but one name on every slip of paper—that of Florence 
Nightingale. 

“She went back to England under an assumed 
name, and reached her home before it was known that 
she had left Turkey. The queen sent for her and 
thanked her in person at Balmoral. Every soldier in 
the army contributed a day’s pay to a fund of $250,000 
for their benefactor, but she gave it all to found the 
Florence Nightingale Training School for Nurses in 
London. The Geneva convention and the Red Cross 
Society were the eventual outcome of her labors in the 
east.” 

The difficulties which she had to contend with can 
never be fully appreciated at this time when women’s 


24 


Florence Nightingale 


service as nurses in the army in most civilized coun¬ 
tries is well established. Her biographer writing of 
that period says : 

“Miss Nightingale’s work in the Crimea was at¬ 
tended by ceaseless worry. She had to fight her way 
into full authority. She knew that she would win, but 
her enemies were active, and were for the moment in 
possession of the field. ‘There is not an official,’ she 
said, ‘who would not burn me like Joan of Arc, if he 
could, but they know that the War Office cannot turn 
me out because the country is with me. # * * The real 
grievance against us is that though subordinate to 
the medical chiefs in office, we are superior to them in 
influence, and in the chance of being heard at home.’ ” 

It is not easy to suggest the many qualities of char¬ 
acter in Miss Nightingale which the experiences in 
the Crimea brought out into bold relief—qualities 
which are just as much needed in nursing today as 
they were then. Her unflinching endurance of the 
hardships which the conditions forced upon her; her 
generous recognition of the work of others; her 
thoughtful care of the nurses who had been entrusted 
to her, under the most difficult conditions—should be 
remembered quite as much as her wonderful organiz¬ 
ing qualities, her keen insight into situations, and her 
general ability to produce results—to bring things to 
pass. It was a recognition of these latter qualities that 
led Queen Victoria to exclaim: “Such a clear head! I 
wish we had her at the War Office.” 

After the war was over and a general inquiry as 
to conditions and methods of sanitary improvement in 
regard to the army had been started in London, an 
army doctor writing of her said: “It may surprise 
many persons to find from Miss Nightingale’s evi¬ 
dence that, added to feminine graces, she possesses 


Service in the Crimean War 


25 


not only the gift of acute perception, but that on all 
the points submitted to her she reasons with a strong, 
acute, most logical, and if we may say so, masculine 
intellect, that may well shame other witnesseses. 
They maunder through their subject, as if they had 
by no means made up their minds on any one point— 
they would, and they would not; and they seem almost 
to think that two parallel roads may sometimes be 
made to meet, by dint of courtesy and good feeling, 
amiable motives that should never be trusted to in 
matters of duty. When you have to encounter hydra¬ 
headed monsters of officialism and ineptitude, straight 
hitting is the best mode of attack. Miss Nightingale 
shows that she not only knows her subject, but feels 
it thoroughly. There is, in all she says, a clearness, 
a logical coherence, a pungency and abruptness, a 
ring as of true metal, that is altogether admirable.” 

To have failed in appreciation of the part her as¬ 
sistant nurses played, during the excitement of war¬ 
time conditions, would have been easy and, to a de¬ 
gree, excusable—but she did not fail. To take the 
whole credit for achievement to oneself is a very hu¬ 
man failing, but it was not one of Florence Nightin¬ 
gale’s failings.' 

One illustration of her appreciation of her asso¬ 
ciates in the campaign shows this characteristic plain¬ 
ly. Of one woman whom she had placed in a position 
of more than ordinary responsibility, she wrote: 
“Without her, our Crimean work would have come to 
grief—without her judgment, her devotion, her un¬ 
selfish, consistent looking to the one great end—the 
carrying out of the work as a whole—without her un¬ 
tiring zeal, her accuracy in all trusts and accounts, 
her truth, her faithfulness. Her praise and reward are 
in higher hands than mine.” 


26 


Florence Nightingale 


In describing to the Secretary of State certain sani¬ 
tary reforms which she carried out in the hospitals of 
Scutari, she wrote: “I must pay my tribute to the in¬ 
stinctive delicacy, the ready attention of orderlies and 
patients during all that dreadful period. For my sake 
they performed offices of this kind (which they neither 
would for the sake of discipline, nor for that of im¬ 
portance to their own health, which they did not 
know), and never was there one word nor one look 
which a gentleman would not have used; and while 
paying this humble tribute to humble courtesy, the 
tears come into my eyes as I think how amidst scenes 
of loathsome disease and death, there rose above it all 
the innate dignity, gentleness, and chivalry of the 
men, shining in the midst of what must be considered 
the lowest sinks of human misery, and preventing, in¬ 
stinctively, the use of one expression which could dis¬ 
tress a gentlewoman.” 

It is easy to think of Miss Nightingale as a great 
organizer and executive—it is less easy to imagine 
how she found time to give the personal attention to 
the individual patient that she did give. “She was 
wonderful,” said one, “at cheering up any one who was 
a bit low.” In the midst of her manifold responsibili¬ 
ties she found time to write hundreds of letters, to 
relatives at home, for those unable to write, and to in¬ 
still in the nurses associated with her the same spirit. 
There was nothing mechanical in the nursing of that 
period. Every patient was a human being with rela¬ 
tives and anxious friends rightfully interested, who 
must be kept informed as to his condition, as far as 
possible. 

TEACHING A COUNTRY BY DEMONSTRATION. 

Nowadays when women of many classes are con¬ 
tending that legislation is necessary before real re- 


Service in the Crimean War 


27 


forms can be brought about, it is interesting to note 
that Florence Nightingale’s reforms were initiated 
mainly by demonstration of the way a thing could be 
accomplished. Her biographer, in writing of this, 
says that “it was a common belief of the time that it 
was in the nature of the British soldier to be drunken. 
The same idea was entertained of the British nurse. 
Miss Nightingale utterly refused to believe it.” Writ¬ 
ing to a friend, while in Scutari, she remarks: “I have 
never been able to join in the popular cry about the 
recklessness, sensuality and helplessness of the sol¬ 
diers. On the contrary, I should say that I have never 
seen so teachable and helpful a class as the army gen¬ 
erally. Give them opportunity, promptly and securely, 
to send money home and they will use it. Give them 
schools and lectures and they will come to them. Give 
them books and games and amusements and they will 
leave off drinking. Give them suffering and they will 
bear it. Give them work to do and they will do it.” 

Acting on this belief, we find Miss Nightingale, in 
addition to her wofk in improving the nursing in the 
army, arranging plans by which soldiers might remit 
money to their relatives, by forming an extempore 
money order office where, on four afternoons each 
month, she personally received money from soldiers 
and arranged for sending it to relatives in England. 
Soon the government took the hint which she thus 
gave them—and established money order offices at 
different points where the troops were stationed. 

Along the same practical line was her effort to 
combat the drink habit by establishing a coffee house, 
the details of which she arranged. Her next practical 
step was the establishment of reading rooms and class 
rooms—which were fitted up with textbooks, copy 
books, prints, maps, games, etc., secured from per- 


28 


Florence Nightingale 


sonal friends in the home land. On her request, two 
schoolmasters were sent out from England to take 
charge of “the education of the army.” 

Scarcely had she returned from the Crimea than 
she began her long campaign for better sanitary con¬ 
ditions in the army, wherever it might be called in the 
future. “We can do no more,” she said, “for those who 
have suffered and died in their country’s service; they 
need our help no longer; their spirits are with God who 
gave them. It remains for us to strive that their suf¬ 
ferings may not have been endured in vain—to en¬ 
deavor so to learn from experience as to lessen such 
sufferings in future by forethought and wise manage¬ 
ment.” 




“Notes on Hospitals” 

Chapter III. 

“It may seem a strange principle to enunciate,” 
wrote Miss Nightingale in 1863, “as the very first re¬ 
quirement in a hospital that it should do the sick no 
harm. It is quite necessary, nevertheless, to lay down 
such a principle, because the actual mortality in hos¬ 
pitals, especially in those of large crowded cities is 
very much higher than any calculation founded on the 
mortality of the same class of diseases among patients 
out of hospitals would lead us to expect.” 

At the time Miss Nightingale returned from the 
Crimea, the death rate in hospitals was lamentably 
high, and it was but natural that she should turn her 
attention to remedying such conditions, or at least to 
call attention to them. In 1858 her book, “Notes on 
Hospitals,” was issued. A noted man in acknowledg¬ 
ing receipt of a copy stated that it appeared to him to 
be the most valuable contribution to sanitary science 
in application to medical institutions, that he had ever 
seen. In this book we find her calling attention to 
overcrowding, lack of drainage under hospitals, to 
ventilation, to the necessity of having non-absorbent 
floors and walls, to the desirability of iron beds, hair 
mattresses, and glass or earthen ware cups, instead of 
tin—also to needed improvements in hospital kitchens 
and laundries, to the curative effects of light—all of 
which ideas are today regarded as essentials in hos¬ 
pitals, but which were then years in advance of general 
practice. It is easy to point out defects—not always 
so easy to produce practical plans for correcting them, 
but Miss Nightingale not only called attention to the 
defects but at the same time showed how to remedy 
them. In the second edition of the book she enumer¬ 
ated “Sixteen Sanitary Defects in the Construction of 


30 


Florence Nightingale 


Hospital Wards”—accompanying each statement with 
definite plans for correcting the defect. The publica¬ 
tion of this little book on hospitals brought to her nu¬ 
merous requests for consultation regarding the con¬ 
struction of new hospitals which were being planned 
and more than a dozen hospitals constructed, soon 
after that time, had the benefit of her advice and de¬ 
tailed consideration of the architect’s plans. The 
questions as to the desirability of pavilion construc¬ 
tion and whether a hospital should be built in the midst 
of a well-populated section, and among the class of 
people it is expected to serve—or in a more distant 
location, where better light and air are to be had— 
which are still debated among hospital people, were 
then as hotly debated as now. It was not unusual to 
find her making out the main specifications for an 
entire hospital building regarding which her advice 
had been sought, and architects and sanitary engi¬ 
neers were very glad to be able to quote her approval 
of their plans. Sir Edward Cook, her biographer, 
states that “in its day, Miss Nightingale’s Notes on 
Hospitals revolutionized many ideas, and gave a new 
direction to hospital construction.” 

“NOTES ON NURSING.” 

Between the return of Miss Nightingale from the 
Crimea, and the starting of the first real training 
school for nurses some three or four years elapsed, 
which were largely devoted to the securing of better 
sanitary conditions for the army—and in tedious and 
exhaustive work with military officials and legislators, 
in addition to her work in improving hospital buildings 
and methods. 

During this time, her book, Notes on Nursing, was 
issued, in order to deepen the impression she was try¬ 
ing to make, that nursing skill was not something 


Notes ox Hospitals. 


31 


simply to be “picked up” by any woman, but that it 
required special gifts, special training—training by 
precept, as well as by example. The book furnished 
the precept teaching for that time, and was immensely 
popular. It is safe to say that no book on nursing 
which has appeared since, or which probably ever will 
appear, was received with the enthusiasm, that this 
book of hers aroused among all sorts of people, from 
the queen down to the laborer’s wife. It many ways, 
it was a remarkable book—remarkable in the under¬ 
lying principles set forth, now, well understood and ac¬ 
cepted, yet then a new story—and remarkable for its 
keen appreciation of the needs of the sick. Nurses of 
today, even graduates, might very profitably try to 
really learn and practice some of the lessons contained 
in that little book, written more than half a century 
ago. Her gospel of fresh air, and its application to 
health, was a new gospel at that time—yet after all 
these years it is still unheeded in many homes. 

QUOTATIONS FROM HER “NOTES ON NURSING.” 

“Do you ever go into the bedrooms of any persons 
of any class, whether they contain one, two or twenty 
people, whether they hold sick or well at night, or be¬ 
fore the windows are opened in the morning and ever 
find the air anything but unwholesomely close and 
foul? And why should it be so? During sleep the 
human body even when in health, is far more injured 
by the influence of foul air than when awake. Why 
can’t you keep the air all night, then, as pure as the air 
without in the rooms you sleep in? But for this you 
must have sufficient outlet for the impure air you 
make yourselves, to go out; and sufficient inlet for the 
pure air from without to come in. You must have 
open chimneys, open windows or ventilators; no close 


32 


Florence Nightingale 


curtains round your beds; no shutters or curtains to 
your windows; none of the contrivances by which you 
undermine your own health or destroy the chances of 
recovery of the sick.” 

“Let no one ever depend upon fumigations, ‘disin¬ 
fectants,’ and the like for purifying the air. The of¬ 
fensive thing, not its smell, must be removed. A cele¬ 
brated medical lecturer began one day, ‘Fumigations, 
gentlemen, are of essential importance. They make 
such an abominable smell that they compel you to 
open the windows.’ ” 

“True nursing ignores infection except to prevent 
it. Cleanliness and fresh air from open windows with 
unremitting attention to the patient, are the only de¬ 
fence a true nurse either needs or asks.” 

######## 

“The very first canon of nursing, the first and the 
last thing upon which a nuse’s attention must be fixed, 
the first essential to a patient, without which all the 
rest you can do for him is as nothing, with which 
I had almost said you may leave all the rest alone, is 
this: To keep the air he breathes as pure as the 
external air, without chilling him.” 

##****#* 

“The time when people take cold (and there are 
many ways of taking cold, besides a cold in the nose), 
is when they first get up after the two-fold exhaus¬ 
tion of dressing and of having had the skin relaxed by 
many hours, perhaps days, in bed, and thereby ren¬ 
dered more incapable of reaction. Then the same 
temperature which refreshes the patient in bed may 
destroy the patient just risen. And common sense will 
point out, that, while purity of air is essential, a tem¬ 
perature must be secured which shall not chill the 
patient.” 


Notes on Hospitals 


33 


“Of all methods of keeping patients warm the very 
worst certainly is to depend for heat on the breath and 
bodies of the sick.” 

**###### 

“To be ‘in charge’ is certainly not only to carry 
out the proper measures yourself, but to see that every 
one else does so too; to see that no one either wilfully 
or ignorantly thwarts or prevents such measures. It 
is neither to do everything yourself nor to appoint a 
number of people to each duty, but to ensure that each 
does that duty to which he is appointed.” 

“Conciseness and decision are, above all things, 
necessary with the sick. Let your thought expressed 
to them be concisely and decidedly expressed. What 
doubt and hesitation there may be in your own mind 
must never be communicated to theirs.” 

“What can’t be cured must be endured,” is the very 
worst and most dangerous maxim for a nurse which 
ever was made. Patience and resignation in her are 
but other words for carelessness or indifference—con¬ 
temptible, if in regard to herself; culpable, if in regard 
to her sick.” 

“I would appeal most seriously to all friends, vis¬ 
itors, and attendants of the sick to leave off this prac¬ 
tice of attempting to ‘cheer’ the sick by making light 
of their danger and by exaggerating their probabilities 
of recovery.” 

“A sick person intensely enjoys hearing of any ma¬ 
terial good, any positive or practical success of the 
right. He has so much of books and fiction, of prin¬ 
ciples, and precepts, and theories; do, instead of ad¬ 
vising him with advice he has heard at least fifty times 


34 


Florence Nightingale 


before, tell him of one benevolent act which has really 
succeeded practically,—it is like a day’s health to him. 
You have no idea what the craving of sick with un¬ 
diminished power of thinking, but little power of doing, 
is to hear of good practical action, when they can no 
longer partake in it.” 

“The most important practical lesson that can be 
given to nurses is to teach them what to observe—how 
to observe—what symptoms indicate improvement— 
what the reverse—which are of importance—which 
are of none—which are the evidence of neglect—and 
of what kind of neglect. All this is what ought to 
make part, and an essential part, of the training of 
every nurse.” 

##*##### 

“Courts of justice seem to think that anybody can 
speak ‘the whole truth, and nothing but the truth,’ if 
he does but intend it. It requires many faculties com¬ 
bined of observation and memory to speak ‘the whole 
truth,’ and to say ‘nothing but the truth.’ 

‘I knows I fibs dreadful, but believe me, Miss, I 
never finds out I has fibbed until they tells me so,’ was 
a remark actually made. It is also one of much more 
extended application than most people have the least 
idea of.” 

“There may be four different causes, any of which 
will produce the same result, viz., the patient slowly 
starving to death from want of nutrition: 

1. Defect in cooking; 

2. Defect in choice of diet; 

3. Defect in choice of hours for taking diet; 

4. Defect of appetite in patient. 


Notes on Hospitals 


35 


Yet all these are generally comprehended in the one 
sweeping assertion that the patient has ‘no appetite.’ ” 

**###### 

“If you cannot get the habit of observation one 
way or other, you had better give up the being a nurse, 
for it is not your calling, however kind and anxious 
you may be.” 

“It appears that scarcely any improvement in the 
faculty of observing is being made. Vast has been the 
increase of knowledge in pathology—that science 
which teaches us the final change produced by disease 
on the human frame—scarce any in the art of observ¬ 
ing the signs of the change while in progress. Or, 
rather, is it not to be feared that observation, as an 
essential part of medicine, has been declining?” 

“In dwelling upon the vital importance of sound 
observation, it must never be lost sight of what observ¬ 
ation is for. It is not for the sake of piling up miscel¬ 
laneous information or curious facts, but for the 
sake of saving life and increasing health and comfort. 
The caution may seem useless, but it is quite surpris¬ 
ing how many men (some women do it too), prac¬ 
tically behave as if the scientific end were the only 
one in view, or as if the sick body were but a reservoir 
for stowing medicines into, and the surgical disease 
only a curious case the sufferer has made for the 
attendant’s special information.” 

##*###** 

“Pathology teaches the harm that disease has 
done. But it teaches nothing more. We know noth¬ 
ing of the principle of health, the positive of which 
pathology is the negative, except from observation and 
experience. And nothing but observation and ex¬ 
perience will teach us the ways to maintain or to bring 
back the state of health.” 


36 


Florence Nightingale 


“Unnecessary noise, then, is the most cruel absence 
of care which can be inflicted on the sick or well. 
Unnecessary (although slight) noise injures a sick 
person much more than necessary noise, of a much 
greater amount. A good nurse will always make sure 
that no door or window in her patient’s room shall 
rattle or creak; that no blind or curtain shall, by any 
change of wind through the open window, be made to 
flap. If you wait till your patients tell you of these 
things, where is the use of their having a nurse.” 

“Always sit within the patient’s view, so that when 
you speak to him he has not painfully to turn his head 
round in order to look at you. Everybody involuntarily 
looks at the person speaking. If you make this act a 
wearisome one on the part of the patient, you are 
doing him harm.” 

“Volumes are now written and spoken upon the 
effect of the mind upon the body. Much of it is true. 
But I wish a little more was thought of the effect of 
the body on the mind. * * * A patient can just as 

much move his leg when it is fractured, as change his 
thoughts when no external help from variety is given 
him. # * * It is an ever-recurring wonder to see 

educated people who call themselves nurses, acting 
thus. They vary their own objects, their own employ¬ 
ments, many times a day; and while nursing (?) some 
bedridden sufferer they let him lie there staring at a 
dead wall, without any change of object to enable him 
ro vary his thoughts; and it never occurs to them, at 
least to move his bed so that he can look out of the 
window.” 

“It is often thought that medicine is the curative 
process. It is no such thing; medicine is the surgery 
of functions, as surgery proper is that of limbs and 


Notes on Hospitals. 


37 


organs. Neither can do anything but remove obstruc¬ 
tions; neither can cure. Nature alone cures.” 

“A celebrated man has told us that one of the main 
objects in the education of his son, was to give him a 
ready habit of accurate observation, a certainty of per¬ 
ception and that for this purpose one of his means was 
a month’s course as follows: He took the boy rapidly 
past a toy-shop; the father and son then described to 
each other as many of the objects as they could, which 
they had seen in passing the windows, noting them 
down with pencil and paper and returning afterward 
to verify their own accuracy. I have often thought 
how wise a piece of education this would be for higher 
objects; and in our calling of nurses the thing itself is 
essential. For it may safely be said not that the habit 
of ready and correct observation will by itself make 
us useful nurses, but that without it we shall be use¬ 
less with all our devotion.” 

“It seems a commonly received idea among men 
and even among women themselves that it requires 
nothing but a disappointment in love, the want of an 
object a general disgust, or incapacity for other things, 
to turn a woman into a good nurse. This reminds 
one of the parish where a stupid old man was sent to 
be schoolmaster because he ‘was past keeping the 
pigs’.” 

######## 

“And remember every nurse should be one who is 
to be depended upon, in other words, capable of being 
a ‘confidential’ nurse. She does not know how soon 
she may find herself placed in such a situation; she 
must be no gossip, no vain talker; she should never 
answer questions about her sick except to those who 
have a right to ask them; she must, I need not say, be 
strictly sober, and honest; but more than this, she 


38 


Florence Nightingale 


must be a religious and devoted woman; she must 
have a respect for her own calling because God’s 
precious gift of life is often literally placed in her 
hands; she must be a sound and close and quick 
observer; and she must be a woman of delicate and 
decent feeling.” 

“The everyday management of a large ward let 
alone of a hospital—the knowing what are the laws of 
life and death for men and what the laws of health for 
wards—are not these matters of sufficient importance 
and difficulty to require learning by experience and 
careful inquiry, just as much as any other art? They 
do not come by inspiration to the lady disappointed in 
love, nor to the poor workhouse drudge hard up for a 
livelihood.” 

“To revert to children. They are much more sus¬ 
ceptible than grown people to all noxious influences. 
They are affected by the same things, but much more 
quickly and seriously, viz., by want of fresh air, or 
proper warmth, want of cleanliness, in house clothes, 
bedding or body, by startling noises, improper food, or 
want of punctuality; by dulness and by want of light; 
by too much or too little covering in bed; or when up, 
by want of the spirit of management generally in those 
in charge of them. One can therefore, only press the 
importance, as being yet greater in the case of chil¬ 
dren, greatest in the case of sick children, of attend¬ 
ing to these things.” 


The Nightingale Training School 
For Nurses 

Chapter IV. 

Deep as was the desire of Miss Nightingale to insti¬ 
tute plans for the training of hospital nurses, her 
health, after her return from the army service, was so 
impaired, that to undertake the task herself was im¬ 
possible. The fund of $250,000 had been placed in 
charge of a board of trustees and invested for the 
purpose of establishing a school of which she expected 
to be the superintendent. Her health, however, grew 
worse rather than better, and after two years had 
passed, she wrote to the Chairman of the Council of 
the Nightingale Fund, of her inability to carry out the 
plans. It became necessary to find other persons 
through whom she might work, without having to 
carry the everyday details. Her choice fell on St. 
Thomas’ Hospital—largely because “the matron of 
the hospital, Mrs. Wardroper, was a woman after Miss 
Nightingale’s own heart, strong, devoted to her work, 
devoid of all self-seeking, full of decision and admin¬ 
istrative ability.” Of this remarkable woman, Mrs. 
Wardroper, who for twenty-seven years was superin¬ 
tendent of the Nightingale School, Miss Nightingale 
has left a character sketch: 

# “I saw her,” she says, “first, in October, 1854, 
when the expedition of nurses was sent to the Crimean 
war. She had been then nine months matron of the 
great hospital in London, of which for 33 years, she 
remained head, and reformer of nursing. Training was 
then unknown; the only nurse worthy of the name 
that could be given to the expedition was a ‘Sister’ who 
had been pensioned some time before and who proved 
invaluable. I saw her next after the conclusion of the 
war. She had already made her mark; she had weeded 


40 


Florence Nightingale 


out the inefficient, morally and technically; she had 
obtained better women as nurses; she had put her 
finger on some of the most flagrant blots, such as the 
night nursing, and where she laid her finger, the blot 
was diminished as far as possible, but no training had 
yet been thought of. 

“Her power of organization, her courage and dis¬ 
crimination in character, were alike remarkable. She 
was straightforward, true, upright. She was decided. 
Her judgment of character came by intuition, at a 
flash, not by much weighing and consideration. Yet 
she rarely made a mistake, and she would take the 
greatest pains in her written delineations of character 
required for record, writing them again and again in 
order to be perfectly just. She was free from self- 
consciousness; nothing artificial about her. She did 
nothing, and abstained from nothing because she was 
being looked at. Her whole heart and mind were in 
the work she had undertaken. 

“She was left a widow at 42 with a young family. 
She had never had any training in hospital life for 
there was none to be had. Her force of character was 
extraordinary. Her word was law. * * * she 

knew what she wanted and did it. She was a strict 
disciplinarian; very kind, often affectionate rather 
than loving. * * * She was a thorough gentle¬ 

woman, nothing mean or low about her; magnanimous 
and generous rather than courteous. All this was 
done quietly. She had a hard life but never proclaimed 
it. What she did was done silently.” 

Such was Miss Nightingale’s estimate of the first 
superintendent of a training school for nurses organ¬ 
ized according to her own ideas. Mrs. Wardroper re¬ 
tired in 1887 and died in 1892. The plans for the train¬ 
ing school were of Miss Nightingale’s making—the 

♦British Medical Journal, Dec. 31, 1892. 


Training School for Nurses 


41 


carrying of them out devolved almost wholly on Mrs. 
Wardroper, and on the Resident Medical Officer of the 
hospital, R. G. Whitfield. 

There were two essential principles to the plan: 
The nurses were to have their technical training in 
hospitals specially organized for the purpose. They 
should live in a home fit to form their moral life and 
discipline. Plans for lectures were carefully made and 
carried out, and a “Monthly Sheet of Personal Char¬ 
acter and Acquirements” of each nurse was arranged 
by Miss Nightingale herself, for the Matron to fill in. 
The character record was to be noted under five heads: 
punctuality, quietness, trustworthiness, personal neat¬ 
ness and cleanliness, and ward management. 

The records in regard to nursing technique were 
made out on forms carefully prepared by Miss Night¬ 
ingale under numerous headings, with copious sub¬ 
headings. At her request, the Resident Medical Officer 
prepared a form of General Directions which were to 
aid the nurses in taking notes of the medical and surg¬ 
ical cases in the hospitals. 

The school opened June 24th, 1860. The course of 
training was to extend over one year. The writer has 
in her possession a copy of the first set of “Rules and 
Regulations for Probationers Under the Nightingale 
Fund”—and they bear a close resemblance to regula¬ 
tions in force today. She laid foundations which have 
stood the test of time. 

In the first report of the Committee in charge of 
the training school, one finds the details of the quali¬ 
fications expected, set forth as follows, with the added 
statement that all important details for the working of 
the plan have been suggested by Miss Nightingale, or 
submitted to her for approval: 


42 


Florence Nightingale. 


“DUTIES OF PROBATIONERS UNDER THE 
NIGHTINGALE FUND.” 

You are required to be 

Sober 

Honest, 

Truthful 

Punctual 

Quiet and Orderly. 

Cleanly and Neat. 

You are expected to become skilful in-— 

1. In the dressing of blisters, burns, sores, 
wounds, and in applying fomentations, poultices, and 
minor dressings. 

2. In the application of leeches, externally and 
internally. 

3. In the administration of enemas for men and 
women. 

4. In the management of trusses and appliances 
in uterine complaints. 

5. In the best method of friction to the body and 
extremities. 

6. In the management of helpless patients, i. e., 
moving, changing, personal cleanliness, of feeding, 
keeping warm (or cool), preventing and dressing bed¬ 
sores, managing position of. 

7. In bandaging, making bandages and rollers, 
lining of splints, etc. 

8. In making the beds of patients, and removal of 
sheets whilst patient is in bed. 

9. You are required to attend at operations. 

10. To be competent to cook gruel, arrowroot, 
eggflip, puddings, drinks for the sick. 


Training School for Nurses 


43 


11. To understand ventilation, or keeping the 
ward fresh by night as well as by day; you are to be 
careful that great cleanliness is observed in all the 
utensils; those used for the secretions as well as those 
required for cooking. 

12. To make strict observation of the sick in the 
following particulars: 

The state of secretions, expectorations, pulse, skin, 
appetite; intelligence, as delirium or stupor; breathing, 
sleep, state of wounds, eruptions, formation of matter; 
effect of diet or of stimulants, and of medicine. 

13. And to learn the management of convales¬ 
cents. 

IDEALS OF TRAINING. 

Her ideals of training, what she hoped training 
might accomplish, are embodied, in part at least, in 
the following quotations from her writings at a later 
period. 

What is training? Training is to teach the nurse 
to help the patient to live. Nursing the sick is an 
art and an art requiring an organized practical and 
scientific training; for nursing is the skilled servant of 
medicine, surgery and hygiene. A good nurse of 
twenty years ago had not to do the twentieth part of 
what she is required by her physician or surgeon to do 
now; and so after the year’s training she must be still 
training under instruction in her first and even second 
year’s hospital service. The physician prescribes for 
supplying the vital force, but the nurse supplies it. 

Training is to teach the nurse how God makes 
health and how He makes disease. 

Training is to teach a nurse to know her business, 
that is to observe exactly in such stupendous issues as 
life and death, health and disease. 


44 


Florence Nightingale 


Training has to make her not servile, but loyal to 
medical orders and without the independent sense or 
energy of responsibility which alone secures real 
trustworthiness. 

Training is to teach the nurse how to handle the 
agencies within our control which restore health and 
life, in strict intelligent obedience to the physician’s 
or surgeon’s power and knowledge, how to keep the 
health mechanism prescribed to her in gear. 

Training must show her how the effects on life of 
nursing may be calculated with nice precision, such 
care or carelessness, such a sick rate, such a dura¬ 
tion of case, such a death rate.” 

In 1871, St. Thomas’ Hospital removed to the 
large new buildings in its present location near the 
Houses of Parliament, London, and with the occupa¬ 
tion of the new building, the number of nurses and 
probationers in the Nightingale School greatly in¬ 
creased. New problems in management were created 
and Miss Nightingale feared that her high ideals for 
the nurses were not being realized as fully as she de¬ 
sired. Her health having improved, she determined on 
a closer supervision of the school, by herself. One 
result of this supervision, as she herself afterward 
stated, was that “the training school became a Home 
—a place of moral, religious and practical training—a 
place of training character, habits, and intelligence, 
as well as of acquiring knowledge.” She knew as 
much, probably, as any hospital superintendent knows 
today, of the problem of securing the right kind of 
young women to be trained, and she was fully con¬ 
vinced that a good nurse must be first of all a good 
woman. When applications came to her from smaller 
cities and towns for trained nurses to take charge of 
the nursing, she was accustomed to reply, “Have you 
sent me any probationers? I can’t stamp material out 
of the ground.” 


Training School for Nurses 


45 


Her character sketches, as preserved among her 
papers, of some of the probationers she had to deal 
with in those days, show her keen insight into human 
nature. “Miss A. Tittupy, flippant, pretension-y, veil 
down, ambitious, clever, not much feeling, talk-y, 
underbred, no religion, may be persevering from ambi¬ 
tion to excel but takes the thing up as an adventure.” 
“Nurse B. A good little thing, spirited, too much 
friends with G., shares in her flirtations.” “Miss X. 
More cleverness than judgment, more activity than 
order, more hard sense than feeling, never any high 
view of her calling, always thinking more of appear¬ 
ances than of the truth, more flippant than witty, more 
petulance than vigor.” These are typical of her notes 
written after personal conversation with different pro¬ 
bationers. The great necessity of some such notes is 
shown in the enormous demand that had been created 
for trained nurses for other hospitals—to fill respons¬ 
ible positions where they would have the choosing and 
training of other nurses. These demands came to her 
unceasingly in the earlier years of trained nursing. 

Through her influence an assistant superintendent 
of the Nightingale training school had been appointed 
to whom was given the title of Home Sister. The 
duties of the Home Sister were varied, but among 
other things she was expected to supplement the lec¬ 
tures and bedside teaching and demonstration by reg¬ 
ular classes. She was also to “encourage general 
reading, to arrange Bible classes, to give wider inter¬ 
ests to the nurses,” in order, as Miss Nightingale said, 
to keep them above the mere scramble' for a remuner¬ 
ative place. She regarded the influence of the Home 
Sister on the moral and spiritual side of the school as 
more important than her technical instruction. 

It is stated that the besetting sin of the Nightingale 
Nurses in those earlier days was self-sufficiency. 


46 


Florence Nightingale 


“They knew, says a writer, “that their training school 
was the first of its kind, and they were apt to give 
themselves airs.” This tendency in them was vigor¬ 
ously combated by Miss Nightingale. The picking and 
choosing of places or cases in order to select the one 
which afforded the prospects of an easy time, she 
especially condemned. 

“Our brains are pretty nearly useless,” she said, in 
one of her annual addresses to the nurses, “if we only 
think of what we want and should like ourselves; and 
not of what posts are wanting us, or what our posts 
are wanting in us. What would you think of a soldier 
who, if he were put on duty in the honorable post of 
difficulty, as sentry, may be, in the face of the enemy 
(and we nurses are always in the face of the enemy, 
always in the life and death of our patients)—were to 
answer his commanding officer, ‘No, he had rather 
mount guard at the barracks or study musketry;’ or 
if he had to go as pioneer, or on a forlorn hope, were 
to say, ‘no that don’t suit my turn’.” 

It was her custom for some years to issue an an¬ 
nual address to the nurses of the Nightingale School, 
and for many years the authorities of the school in¬ 
sisted on every probationer studying the first of these 
addresses, issued in 1872, the year in which she began 
her closer supervision of the details of training. In 
these addresses she dwelt strongly on the ideals of 
nursing she had from the beginning—that it requires 
a strong sense of vocation or a special call; that it 
needs a religious basis; that it is an art; that there 
must be constant progress or stagnation; that the 
nurse should be extremely careful of her moral in¬ 
fluence. She had no use for the woman who thought 
she was making a sacrifice in taking up nursing; nor 
for the woman who thought any kind of service which 
had to do with nursing was beneath her—neither had 


Training School for Nurses 


47 


she any patience with the sentimental “ministering 
angel” type of nurse. “If we have not true religious 
feeling and purpose,” she said in one of her addresses, 
“hospital lite, the highest of all things icith these 
becomes without them, a mere routine and bustle and 
a very hardening routine and bustle.” 

No one who studies Miss Nightingale’s life and 
ideals can be left in doubt, that, in her mind, in the 
choice of nurses, the first and greatest thing to be con¬ 
sidered was the character of the applicant. She did 
not undervalue education but she believed that the 
spirit of the woman was of supreme importance. 

It is absolutely certain that it was not her medical 
or surgical knowledge, (though this was in advance of 
the times) that accounted for the remarkable and en¬ 
during influence which she exerted, and is still exert¬ 
ing —even though we may seem to have shifted the 
emphasis from some things which to her were of tre¬ 
mendous importance, and placed it on other things 
which, to her mind, were of secondary consideration. 
It is an interesting exercise to analyze the varying 
qualities in her great and beautiful life which still 
exerts its influence on countless other lives. But after 
all, the secret of her. success must be summed up in 
that combination of qualities, that subtle something 
which we call Personality. Her studious avoidance of 
honors of all kinds, her purity of motive, the absolute 
lack of self-seeking, of honor, prestige or profit for 
herself, her courage, tact and quiet perseverance are 
qualities on which nurses of the twentieth century 
may wisely meditate. Nothing is more needed among 
nurses today, than that her spirit, her ideals of life and 
character, may be perpetuated. Few of us can render 
any greater service to our generation than to exert 
ourselves to keep her spirit alive in the nursing pro¬ 
fession. 


48 


Florence Nightingale 


library OF CONGRESS 


0 033 261 125 2 


min 


Author’s note.—For many of the facts, which form 
the foundation of this sketch, the author is indebted 
to the authorized biography entitled “The Life of 
Florence Nightingale,” by Sir Edward Cook, published 
in two volumes by the McMillan Co., 1913. Quotations 
have been made from clippings, in several instances, in 
which the name of the journal in which they first ap¬ 
peared has been lost. Grateful acknowledgment is 
hereby made for all such unknown sources of aid used 
in preparing these biographical notes. 






